Vaccines: The Week in Review

11 January 2010
Center for Vaccine Ethics & Policy
http://www.centerforvaccineethicsandpolicy.org/
A program of
- Center for Bioethics, University of Pennsylvania
http://www.bioethics.upenn.edu/
- The Wistar Institute Vaccine Center
http://www.wistar.org/vaccinecenter/default.html
- Children’s Hospital of Philadelphia, Vaccine Education Center
http://www.chop.edu/consumer/jsp/microsite/microsite.jsp

This weekly summary targets news and events in the global vaccines field gathered
from key governmental, NGO and company announcements, key journals and
events. This summary provides support for ongoing initiatives of the Center for
Vaccine Ethics & Policy, and is not intended to be exhaustive in its coverage.
Vaccines: The Week in Review is now also posted in a blog format at
http://centerforvaccineethicsandpolicy.wordpress.com/. Each item is treated as an individual
post on the blog, allowing for more effective retrospective searching. Given email
system conventions and formats, you may find this alternative more effective. This
blog also allows for RSS feeds, etc.
Comments and suggestions should be directed to David Curry, Editor and
Executive Director of the Center, at
david.r.curry@centerforvaccineethicsandpolicy.org. We also invite you to visit
VaccineEthics.org www.vaccineethics.org/ which complements this weekly review
and is edited by Jason Schwartz, MBE, Center for Bioethics.

The WHO continues to issue weekly “updates” and briefing notes on the
H1N1 pandemic at: http://www.who.int/csr/disease/swineflu/en/index.html
Pandemic (H1N1) 2009 - update 82 Weekly update
8 January 2010
As of 3 January 2009, worldwide more than 208 countries and overseas
territories or communities have reported laboratory confirmed cases of
pandemic influenza H1N1 2009, including at least 12799 deaths….
Situation update:
The most active areas of pandemic influenza transmission currently are in
parts of central, eastern and southeastern Europe, North Africa, and South
Asia.
In Europe, pandemic influenza transmission remains geographically
widespread throughout the continent and there continues to be intense virus
circulation in several countries of central, eastern, and southeastern Europe -
particularly in Poland, Serbia, Ukraine, Georgia - where a high a intensity of
respiratory diseases activity has been recently reported. Among countries
testing more than 20 clinical specimens from sentinel sites in the past week,
the greatest proportions of samples testing positive for influenza were
observed in Greece (72%), Georgia (54%), Switzerland (49%), Portugal (48%),
Germany (48%), Luxembourg (40%), Romania (30%), Poland (25%), and
Albania (23%). In most of western and northern Europe, rates of ILI/ARI
continued to decline substantially, and in many places have returned to near
seasonal baselines. Sporadic cases of seasonal H3N2 influenza have been
identified in Western Europe but in very small numbers. Crude mortality rates
among most European countries, measured as the cumulative number of
pandemic H1N1 influenza associated deaths per million population, appear to
be within the same range as rates observed elsewhere in northern and
southern hemisphere, suggesting a relatively consistent global pattern of
mortality…
More at: http://www.who.int/csr/don/2010_01_08/en/index.html

The Bill & Melinda Gates Foundation announced three senior staff
appointments. Each will report directly to Tachi Yamada, president
of the foundation’s Global Health Program.
- Jaime Sepulveda was promoted to Senior Fellow and will serve as a deputy
to Yamada, “playing a central role in shaping the foundation’s overall global
health strategy as part of its executive team. He will work closely with key
foundation partners—including the GAVI Alliance, where he chairs the
Executive Committee—to increase access to vaccines and other effective
health solutions in developing countries. He will also serve as Director of
Special Initiatives in the Global Health Program.
- Gary Darmstadt becomes Director of Family Health, “overseeing a
multidisciplinary team of program and technical experts to develop and
implement strategies to improve maternal, newborn, and child health;
nutrition; and family planning.”
- Girindre Beeharry will become Director of Strategy, “leading a team of
strategy and evaluation experts to help guide strategic planning across the
Global Health Program. His team will help ensure that the foundation’s grant
portfolio has the greatest possible impact on health in developing countries.”
http://www.gatesfoundation.org/press-releases/Pages/sepulveda-darmstadt-
beeharry-leadership-roles-100106.aspx

Global Immunization News (GIN) for 23 December 2009 was

published by WHO on 5 January 2010. This issue includes notice of WHO’s
revised New and Under-utilized Vaccines Implementation (NUVI)
website www.who.int/nuvi with information on the following strategic work
areas:
- Country Decision Making
- Vaccine Products
- Surveillance and Monitoring
- Advocacy and Communication
- Immunization Financing
- Integrated Approaches to Disease Control and Prevention
http://www.who.int/immunization/GIN_December_2009.pdf

The Weekly Epidemiological Record (WER) for 8 January 2009, vol.

85, 1/2 (pp 1–12) includes: Conclusions and recommendations of the Advisory
Committee on Poliomyelitis Eradication, November 2009
http://www.who.int/wer/2010/REH_01-02.pdf

The MMWR for 8 January 2010 / Vol. 58 / No. 51 & 52 includes:

- Patients Hospitalized with 2009 Pandemic Influenza A (H1N1) --- New York
City, May 2009
- Outbreak of 2009 Pandemic Influenza A (H1N1) at a School --- Hawaii, May
2009
- Announcement: National Influenza Vaccination Week --- January 10--16,
2010
- Recommended Immunization Schedules for Persons Aged 0 Through 18
Years --- United States, 2010

Journal Watch
[Editor’s Note]
Vaccines: The Week in Review continues its weekly scanning of key journals
to identify and cite articles, commentary and editorials, books reviews and
other content supporting our focus on vaccine ethics and policy. Journal
Watch is not intended to be exhaustive, but indicative of themes and
issues the Center is actively tracking. We selectively provide full text of
some editorial and comment articles that are specifically relevant to our
work. Successful access to some of the links provided may require
subscription or other access arrangement unique to the publisher. Our initial
scan list includes the journals below. If you would like to suggest other titles,
please write to David Curry at
david.r.curry@centerforvaccineethicsandpolicy.org

JAMA
Vol. 303 No. 1, pp. 9-90, January 6, 2010
http://jama.ama-assn.org/current.dtl
Editorials
2009 Influenza A(H1N1) Monovalent Vaccines for Children
Anthony E. Fiore; Kathleen M. Neuzil
Preliminary Communications
Immunogenicity of a Monovalent 2009 Influenza A(H1N1) Vaccine in
Infants and Children: A Randomized Trial
Terry Nolan, MBBS, PhD; Jodie McVernon, MBBS, PhD; Maryanne Skeljo, PhD;
Peter Richmond, MBBS; Ushma Wadia, MBBS; Stephen Lambert, MBBS,
MAppEpid; Michael Nissen, BMedSc, MBBS; Helen Marshall, MBBS, MPH;
Robert Booy, MD, MSc; Leon Heron, MBChB, MPH; Gunter Hartel, MS, PhD;
Michael Lai, MBBS, MMedSc; Russell Basser, MBBS, MD; Charmaine Gittleson,
MBBCh; Michael Greenberg, MD, MPH
JAMA. 2010;303(1):37-46. Published online December 21, 2009
(doi:10.1001/jama.2009.1911).
Context In the ongoing influenza pandemic, a safe and effective vaccine
against 2009 influenza A(H1N1) is needed for infants and children.
 Objective To assess the immunogenicity and safety of a 2009 influenza
A(H1N1) vaccine in children.
Design, Setting, and Participants Randomized, observer-blind, age-
stratified, parallel group study assessing 2 doses of an inactivated, split-virus
2009 influenza A(H1N1) vaccine in 370 healthy infants and children aged 6
months to less than 9 years living in Australia.
Intervention Intramuscular injection of 15 µg or 30 µg of hemagglutinin
antigen dose of monovalent, unadjuvanted 2009 influenza A(H1N1) vaccine
in a 2-dose regimen, administered 21 days apart.
Main Outcome Measures Hemagglutination inhibition assay to estimate the
proportion of participants with antibody titers of 1:40 or greater,
seroconversion, or a significant antibody titer increase, and factor increase in
geometric mean titer. Assessments of solicited adverse events during 7 days
and unsolicited adverse events for 21 days after each vaccination.
Results Following the first dose of vaccine, antibody titers of 1:40 or
greater were observed in 161 of 174 infants and children in the 15-µg group
(92.5%; 95% confidence interval [CI], 87.6%-95.6%) and in 168 of 172 infants
and children in the 30-µg group (97.7%; 95% CI, 94.2%-99.1%).
Corresponding seroconversion rates were 86.8% (95% CI, 80.9%-91.0%) and
94.2% (95% CI, 89.6%-96.8%), and factor increases in geometric mean titer
were 13.6 (95% CI, 11.8-15.6) and 18.3 (95% CI, 15.7-21.4). All participants
demonstrated antibody titers of 1:40 or greater after the second vaccine
dose. Immune responses were robust regardless of age, baseline serostatus,
or seasonal influenza vaccination status. The majority of adverse events were
mild to moderate in severity.
Conclusion One 15-µg dose of vaccine was immunogenic in infants and
children starting at 6 months of age and vaccine-associated reactions were
mild to moderate in severity.
Trial Registration clinicaltrials.gov Identifier: NCT00940108

Journal of Infectious Diseases

1 February 2010 Volume 201, Number 3
http://www.journals.uchicago.edu/toc/jid/current
[No relevant content]

The Lancet
Jan 09, 2010 Volume 375 Number 9709 Pages 93 - 170
http://www.thelancet.com/journals/lancet/issue/current
Perspectives
The art of public health: pneumococcal vaccine coverage in Mexico
Norman Daniels, Atanacio Valencia-Mendoza, Adriane Gelpi, Mauricio
Hernandez Avila, Stefano Bertozzi
If the art of medicine involves making hard choices about how to improve
individual health using evidence but facing uncertainty, then the art of public
health involves making hard choices about improving population health and
distributing it fairly under conditions of limited evidence, uncertainty, social
and political constraints, and professional incentives that may be in conflict
with fairly maximising population health. To illustrate the kind of public
health choices a health minister faces, we focus on a current controversy in
Mexico.

The Lancet Infectious Disease

Jan 2010 Volume 10 Number 1 Pages 1 - 66
http://www.thelancet.com/journals/laninf/issue/current
[Reviewed last week]

Nature
Volume 463 Number 7277 pp9-128 7 January 2010
http://www.nature.com/nature/journal/v462/n7276/
[No relevant content]

New England Journal of Medicine

Volume 362 — January 7, 2010 — Number 1
http://content.nejm.org/current.shtml
[No relevant content]

Pediatrics
January 2010 / VOLUME 125 / ISSUE 1
http://pediatrics.aappublications.org/current.shtml
[Reviewed last week]

PLoS Medicine
(Accessed 10 January 2010)
http://medicine.plosjournals.org/perlserv/?request=browse&issn=1549-
1676&method=pubdate&search_fulltext=1&order=online_date&row_start=1
&limit=10&document_count=1533&ct=1&SESSID=aac96924d41874935d8e1
c2a2501181c#results
[No relevant articles]

Science
8 January 2010 Vol 327, Issue 5962, Pages 113-236
http://www.sciencemag.org/current.dtl
[No relevant content]

Vaccine
Volume 28, Issue 3, Pages 583-868 (8 January 2010)
http://www.sciencedirect.com/science?
_ob=PublicationURL&_cdi=5188&_pubType=J&_acct=C000050221&_version
=1&_urlVersion=0&_userid=10&md5=06a70dff873c73731f4a31331c8deee2
&jchunk=28#28
[Reviewed earlier]